---
type: document
title: RC Sign Permit Application 202211020902548247
file: ../RC Sign Permit Application_202211020902548247.pdf
tags:
  - Russell_County
  - Building_Department
docDate: null
contentType: application/pdf
contentLength: 151716
sha256sum: 55ac099a07ff02f1b3582b62aa14ec23b133e64e32a507430593ef41672f31bd
sha1sum: 1fbdd189880aa5d1d232f3053bd1512ca0d47e50
---

Russell County Building Department 
137 Highland Dr. 

Lebanon, VA  24266 
Phone: 276-889-8012 
    Fax:  276-889-8009 

build@russellcountyva.us 
Josh Stinson – Building Official 

Sign Permit Application 

Property Owner Information 

Name: 

Mailing Address: 

City: State: Zip Code: 

911 Address: Phone: Cell: 

Tax Map I.d.# Septic #: Water Source: 

Directions: 

Applicant Information ( If other than Property Owner) 

Name: 

Mailing Address: 

City/State/ Zip: 

Contractor – Business Name: 

State License # Exp. Date Phone: 

Estimated Cost of Construction:  $ 

Please Complete : 

Size of Sign 

Illuminated 

I hereby certify that I am the owner of the record of the herein described property, or that the proposed work has 
been authorized by the owner of record and that I have been authorized to make this application as a designated 
agent I agree to conform to all applicable state and local regulations, rules and policies and such shall be deemed a 
condition entering into the exercise of the permit. In addition, if a permit is issued, I certify that the code official or 
his authorized representative shall have the authority to enter the area(s) described herein at any reasonable hour for 
the purpose of enforcing the provisions of the applicable code(s). 

Applicant:      Date: 
 Signature 

FOR COUNTY USE ONLY 

Date Application Received:          Received By: 

Building Permit Fee: $   Total Fee Amount: 

Russell County Building Department
137 Highland Dr.
Lebanon, VA. 24266
Phone: 276-889-8012
Fax: 276-889-8009
build@russellcountyva.us
Josh Stinson ~ Building Official

Sign Permit Application

Property Owner Information
Name:

Mailing Address:

Git State: Zip Code:

911 Address: Phone: Cat:

Tax Map Let Septic #: Water Source:

Directions:

Applicant Information (If other than Property Owner)
Name:

Mailing Address:

City/Statel Zip:

Contractor ~ Business Name:

Sate License [sp Dave [Phones

Estimated Cost of Construction: $

Please Complete

of Sign

Mluminated

Thereby certify that Iam the owner ofthe record of the herein described property, or that the proposed work has
been authorized by the owner of record and that I have hecn authorized to make this application as a designated
agent [agree to conform to all applicable state and local regulations, rules and policies and such shall be deemed a
‘condition entering into the exerese ofthe permit. In addition, ia permit i issued, I certify thatthe code official or
his authorized representative shall have the authority to enter the area(s) described herein at any reasonable hour for
the purpose of enforcing the provisions ofthe applicable code(s).

Applicants Date:
Signature
FOR COUNTY USE ONLY
Date Application Received: Received By:

Building Permit Fee: S Total Fee Amow




	Property Owner Information
	Applicant Information ( If other than Property Owner)
	I hereby certify that I am the owner of the record of the herein described property, or that the proposed work has been authorized by the owner of record and that I have been authorized to make this application as a designated agent I agree to conform to all applicable state and local regulations, rules and policies and such shall be deemed a condition entering into the exercise of the permit. In addition, if a permit is issued, I certify that the code official or his authorized representative shall have the authority to enter the area(s) described herein at any reasonable hour for the purpose of enforcing the provisions of the applicable code(s).
	FOR COUNTY USE ONLY
	Date Application Received:                                                      Received By: 
	Building Permit Fee: $                                                      Total Fee Amount:

	Name: 
	Mailing Address: 
	City: 
	State: 
	Zip Code: 
	911 Address: 
	Phone: 
	Cell: 
	Tax Map Id: 
	Septic: 
	Water Source: 
	DirectionsRow1: 
	DirectionsRow2: 
	DirectionsRow3: 
	Name_2: 
	Mailing Address_2: 
	CityState Zip: 
	Contractor  Business Name: 
	State License: 
	Exp Date: 
	Phone_2: 
	Estimated Cost of Construction: 
	Size of Sign: 
	Illuminated: 
	Applicant: 
	Text1: 
	Text2: 
	Text3: 
	Text4: 
	Text5: 
	Text6: 
	Text7: